FOR WSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE

COMMITTEE NAME (Must be same as on Statement of Organization) (Rev. 07,`2003) REPORT
For office U3D Only
Comm . # /
Logged In
IMPORTANT: Indicate typo of committee you are reporting for:
Scanned
( t )Statewide/Leg Islatrve Candidate ( 2 )Statewide PAC ( 3 )State Party (a )CountyiLocal Candidate
( 5 )County PAC ( 5 )Ballot l$suelFranchise Committee ( 7 )CountylClty Central Committee Computer
Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name Politi I Party

Office Sought : District (if Senate or House)

.
W s
~

3"-5- &
EASURER (or person filing this report) TELEPHONE DATE SIGNED

Late filed reports are subject to possible civil and criminal penalties .
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLL WIN SENTENCE :
I AM FILING A r --2 REPORT FOR ANIA (1) ELECTION I(2)NON-ELECTION YEAR,
(report date) Indicate one

`CHECK IF AMENDMENT TO REPORT DATED 31 Local Committees, enter Date of Election

Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County S Local Committees, enter County in
which Elect' o is held
(You must continue to file reports until a Notice of Dissolution is filed .)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (This is the total of all monies held
by the committee . This amount MUST be the same as the cash on hand at the end
of the last reporting period, or must be zero if this is first report filed.) . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . ., . S
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A : Cash Contributions total (Attach Schedule A) ('also see in-kind below) , . 
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . ., . . . . . . . . . . . . . . . ., ., . ., . ., . . . . . . . .  .  .  . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TScheduln H applies to Candidates' Committees Only)

SUB-TOTAL ... . .S
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) ("also see debts and loans below) . . . .
Schedule F : Loan Repayments total (Attach Schedule F) . ., . . . . ., . . . . ., . . . . . . . . . ., . . . . . ., ., .  .  ,

CASH ON HAND at the end of this reporting period (it final report, balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

"UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . ., . . . . . . , ., . . . ., ., . . . . . . $ 44.7 S-
_ ~f I
"OUTSTANDING LOANS (From Schedule F -Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) E YES C NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H)

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 FOR INSTRUCTIONS . SEE_ BACK OFFORM SCHEDULE
E IN KIND
COMMITTEE NAME Must be Sam as on staternent of Organization) (Rev, W97) CONTRI6UTIONS

C
CHECK THIS BOX IF
AMENDING FORM
Rc,,;ct Form

DATE RELATIONSHIP DESCRIPTION ESTIMATED d IF FOR

RECEIVED NAME AND AGORESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MVIDDIYR) OF CONTRIBUTOR " (if applicable) CONTRIBUTION VALUE CONTRIBUTION

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'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the _
cornmittee . Relatlonsnlp
(for must Do Shown to the tnird degree of corsanguinity (blood relatives) 7nd afflniry (relatives J Schedule [)
by marnage) . (See Pago 2 of forms packet .) If surname or contributor is the same as candidate, but there is no
familial folatlonshlp, enter "not applicable" in the relationship coluor .

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